tv C-SPAN Weekend CSPAN July 13, 2009 2:00am-6:00am EDT
respiratory pathogen in the city in both may and june, trina decision should be based on the clinical presentations on influenza-like illness and not on test results. . it was extremely labor intensive and not sustainable during the more prolonged or severe pandemic, especially because of the diagnostic capacity. counting every case, it never part of our pandemic plan, we wanted to focus our resources, on collecting the data we needed to make public health decisions. as far as learning from this from the fall, we are planning our surveillance approach that will allow us to monitor this or the trajectory of the outbreak in a more sustainable and efficient way and allow us to identify any changes in the characteristics of the virus. . virus. it will continue to enhance our sent from a surveillance systems which were extremely useful in allowing us to the trajectory of
the african to tell where activity was most intense in this city as well as the age groups impacted. we will probably take a sentinel or sampling approach to case based surveillance for some real animus and mountainous and work with a representative sample of hospitals and primary care clinics to provide information on the types of viruses on the types of viruses circulating since not to h1n1 and allow us to assess whether the virus is clinical and characteristics are changing. i like to work with federal agencies aren't in their academic partners to plan ahead of time for the types of of this clinical studies that we should conduct at the sentinel sites to address the key knowledge gaps such as how best to manage patients who are chronically ill not getting better despite anti-viral treatment and recognize the need for consistent surveillance approach nationwide to allow for better comparison of surveillance members. i probably our biggest challenge this spring was having to put
the and consciously develop a policy on school closures as we began to see more committed to a wide transmission and increasing number of affected schools. at a time this was in a way that we didn't yet have data on how severe or contagious the virus was. we did follow the federal guidance of the time that recommended closure for even one confirmed case in a school which we thought in new york city was unrealistic and unnecessary. our experience however give some opportunities to be better prepared for the fall reflected a wealth of data on both schools were closed and those that were on our watch list but remained open to husband and determine the impact of school closures on the transmission. we are collaborating with cdc on a survey of close calls to help assess both economic impact of school closures on families as well as what children actually did it when not in school. and the rear in the process of reassessing our approach with a fall like many of you with a
more aggressive closure policy likely being limited to this an area where the virus becomes material and especially in children. leslie though not we simply communication. from a risk mitigation perspective it was very talented and beyonce are reassurance regarding our finding that the go over all the illness was mild we were sometimes recommend a more restrictive a extraordinary public-health measures than we normally do for seasonal flu, most obvious thing closing schools. was also very difficult articulating our rationale for how we're approaching our school closure decisions because it wasn't a simple numerical cut off or formula and ensuring timely notification of that particular school committee when a closure decision was made. we also found it difficult to use public message in that sense to help dampen the demands on our emergency departments especially for those less severely ill or the seeking
testing for reassurance are to return to work or school especially for those who didn't have any easy access to medical care. on the other hand, we were in that some of our messages regarding persons who didn't need to seek early treatment and not being heard well, especially among persons who might not consider themselves at higher risk including pregnant women or parents and children with mild asthma. with respect to provider communication it was sometimes challenging to expand our policy differences with cdc especially with respect to respiratory protection as we along with several other states did not recommend it routinely use of a respirators and as was the need for the type of measures and committed these settings, it is unrealistic for persons at high risk in new york city to avoid crowded places. as far as opportunities in which everything else we now have some time i think this summer and based on our experience to improve our communication tools
and messages and that this especially to leverage of the tools that are available palm our federal partners. as well as working through some of our policy differences given that the knowledge we all gain from the spring and findings of the current flu season and the southern hemisphere. i just want to in the during the first two weeks of the outbreak in new york city i used to tell my staff when it was mostly limited to st. francis high school in queens that my nickname for the outbreak was swine flu 2009, the best prepared mr. l ever and though it ended up being much one than in jail or exercise because i'm still learning how we are fortunate in that in the experience we just had and the lessons we learned openness and a much better position to raise the town is we're all concerned about in the fall so thank you and soren that i couldn't talk. [applause] >> our final speaker, the
executive director of the division of health. >> thank you. greetings from the navajo land. i want to extend my greetings to secretary sebelius, secretary napalitano, secretary duncan, and the state government and also all you're distinguished ladies and gentlemen. again i am from the navajo nation and the executive director of the lahood division of health and i'm honored to be here and speak to the distinguished group here. would like to do is alan flag to a high that some of the things we have worked on it in navajo land. i want to give you a sense of where we're coming from by doing , the nomination is only one of over 500 indian nations in this country so i wanted give you a sense of how the indian nations operate, the land base.
also wanted to share with you the lessons learned from our perspective and then also with some recommendations. again in the navajo nation is only one of the over 500 indian nations in the country. and each nation is different. it has its own culture, it has its own way of looking at things, on values and a own way of dealing with the emergencies. for the nomination we are located in the four corners region. we have the land that expands to this id of arizona, new mexico, and utah. and the nomination is about the size of the state of west virginia, 26,000 square miles. the land is mostly rural, 728% of the roads are paved. we have 9,000 miles of public
roads and only 22 percent roads are paved said this means to him that in inclement weather conditions is really hard to get around. the population density is 7.1 persons per square mile so it is a very rural, over the weekend during the fourth of july i was invited to a family gathering near a place called the pine springs. i went from my home and tried to gallop on i cornyn and went west and then it turned right near hot, arizona and turned north and drove 18 miles on dirt roads, washboard, if you know what i'm talking about. it took me one important -- it took me one an hour and 30 minutes to travel 18 miles -- and that is the conditions we have in our communities and on navajo land have 300 people registered, about 200 reside on the nomination. in addition to the three states
region we are also located in three different federal regions under region six in dallas, also have to work with the region eight office in denver, colorado, and also have a third place which is region nine in san francisco so any time that we have to do with different federal programs we have to be aware of a stiff and settings. the health care delivery system is such that the indian health service is the primary health care provider of the navajo people. vesicant organization that is very active and health care delivery system is in the navajo division of health which is where i'm coming from and then also we have when we, that contract writers. programs that and on minister that federal programs that used to be administered by federal agencies and we have indian health services that provide
services to over 200,000 active users and one year we have served about 1.2 patient visits. let me also say that navajo traditional healing practice is still part of the health care delivery system. we have navajo people that get sick and they do not hesitate to utilize the native practitioners and we still hold them very dearly. over the years the navajo nation had to do with a number of public health emergencies, such as tuberculosis, hunter virus, hiv, and other diseases such as salmonella and e. coli and then also sometimes we have to get involved with what we call operation mott left, we also had to help people we had to deal with forest fires and now we also have to get involved with the h1n1. then they give you a sense of
how we dealt with the h1n1 outbreak this past spring. we first got the information in april and right away we set up a meeting with the navajo area indian health services and then initiated the whole alert face for team and then set up an incident management team and then also said of the emergency command center that was manned by the navajo bioterrorism program and then we also resorted to that epidemiology's center and then these programs have the daily contact with the navajo area indian health services, also had to contact with the states of arizona and mexico and it worked very closely with the surrounding 13 counties. and then a very fortunate that we are able to respond quickly
according to the information we got some of the navajo area indian health services, altogether 71 suspected cases that were reported, 13 cases were confirmed, and nine individuals were hospitalized. we were very fortunate that all of these individuals recovered. now let me turn to some of the things that i want to share with you in terms of of the lessons learned and a working with the various entities. so many challenges and then some of the gaps that we saw there were several. one has to do with there are issues of related to multi jurisdictional issues. there is also a lack of comprehensive public health policy, a plan because when you work with the various entities
by the counties in the states, you have to understand them, you have to understand the rules and regulations. there is a definite need to develop formal agreements between the various entities with the nomination and when you don't have a very comprehensive plan, this may contribute to delay as services and also long the delay of distribution of drugs so sometimes we do need medical supplies that need to be delivered quickly which you have to get into checking with someone and that someone is to check with someone else again so that is what we go through, but in spite of all that i think we have a good working relationship with most of the entities that have to work with. secondly there issues related to the lack of infrastructure and information technology. there is a definite need for one
definite strategic national stockpile facility in navajo area, there is also a need for adequate information technology that would allow us to process data collection and also to analysis including disease recording and reporting systems. right now we have to wait and look for one entity for a certain report and didn't and then at the end try to bring in altogether. there are issues related two culturally specific information communication system. for example, one-third of the navajo population speaks navajo language. this means that someone has to take the once the information is translated, then we have to
disseminate the information and the available mass media that we have is to local radio station, is very useful. we have a radio station. it is very useful. we have other radio stations in border towns. we had to resort to some of the staff within a number of bair terrorism programs. we had an individual lady who was good in translating information. she has her own way of doing translation and coming out with good messages. [speaking foreign language] that mean cranks' she was saying you are out there listening to me and i take this time to do your own prevention.
while you are washing your hands, perhaps you can sing happy birthday. [laughter] that is very effective and so i say whenever i get questions about h1n1 i say and this young lady's name is ileana, i say, well, this into a lean man, she says everything is okay then everything will be o.k. so that is the kind of individuals that we have in the communities and these of the kind of individuals that are very rare and they can help us to communicate directly with our constituents and our customers. the other thing that i wanted to mention is due to the remoteness and the mountainous terrain, than that of a pot -- the nomination -- uses mobile telephones and seller of phones and a lot of times to get into
remote areas and you may have a cellphone but it doesn't always work. just as i describe to you over the weekend i went 18 miles north of up by 40. once i got 10 miles away from interstate 40 my cell phone was useless. no communication. i also wanted to know there are issues related to lack of out of quote technical resources and may need to adequately prepare for an emergency, and the outbreaks of any infectious diseases. a lot of times we don't have the real sources. have indian health services as a primary health care provider put in as well documented in his only son and a half the amount that is needed so a lot of times in these cases is indian home services within the have the resources are not that have to become part of our partner so that we also have some existing emergency response structures
that may have to be activated but most of the time there are not properly funded so we have to resort to the existing resources and honor to make it functional let me mention some of the strategy is that help us prepare for the response to h1n1. fortunately the nomination in partnership with the navajo area indian health services in 2006 we did what we call vaccination exercise. the exercise we brought together various governmental agencies including the state, county, law enforcement, a childhood resources and in one day we were able to vaccinate 24,000 people in the span of a hours and this is through the use of 15 distribution sites so with one
day of vaccinating 24,000 that in total lead to vaccinating 80,000 people in one year so that was a very helpful exercise that we did and we repeated the exercise of on. by the timing to the exercise people were vaccinated and able in that one day mack's fascination or able to pick up additional 6,000 but in the end in a given year 2007. able to exceed 80,000 individuals. another thing that we learned was that establish -- we also have begun to use the national incident management system and than by using them for able to utilize this cdc how emergency response and led to the stage, the local government and childhood health directors so in
that process while we have these existing protocols and policies, we are able to do less to these policies and protocols and in the process i think we always learn new things and always trying to make our system is better. so also in the process we are fortunate to have also opening up new doors to other new resources and other technical support. than some of the of opportunities that we seem it again and we hope that h1n1 does not come here again but we have to has has been said by previous speakers, we have to be prepared. the nomination again i am sure this is true for all indian nations, we want to be partners with the states and burners with the counties and also want to make sure that we try to take care of those issues related to
a jurisdictions because a lot of times people do get hung up on jurisdictional issues and i think that needs to be dealt with. also need to deal with what can pertain to cost sharing plans and also need to warm or with plans that can be cornyn in and also have a good public information system. so it's that that we close by saying i do appreciate again for being invited and i think the navajo nation is certainly here along with other indian nations coming here to work with different agencies and the department of health and human services. in particular cdc i think we need to make sure that cdc cannot make sure that all the state agencies contact with all respect of indian nations
throughout the country. and then in summary, i think we are prepared if it does occur and then that we have to do the work involved i hope that we'll get enough resources to augment the health care delivery system and that we know -- now have and be able to work on things. i think it is important and it has been said before we do a proper planning and preparation and certainly this does mean establishing that close working relationship and partnership with all entities in the nation's and it's a barn to work on cost-sharing plans. data and information sharing. of cdc in indian health services, they do have a data warehouse is but a lot of times i think it is very trying to get information out so that is information that needs to be available to all indian nations and then there is definitely a need for technical assistance and training. i think the last thing is public
information is very important. and many times in a country that one size does not for all hands is very important that every state work with respect to indian tribes and nt -- every in the nation has their own resources and individuals who have the resources that we can be able to mobilize and be able to be a part of the work team. then finally again i applaud the the the problem of health and human services for working on preparing for any possible h1n1 outbreak again but in the process i again want to say keep emphasizing that indian tribes need to be involved and indian tribes are ready to work with you. thank you very much. [applause]
>> thank you very much. it is clear that there is a breath of experience and learning and i'm going to open the floor up for questions to the panelists, but let me start off with the question of my own and that is that the epidemic after this point has affected all of our institutions and i would like to just to think about where the legacy of this response is likely to be when it eventually is over. >> [inaudible] i think the legacy for the initial responses to the public health system has really responded in a tremendous way with all the associated organizations in national governance council has been a really instrumental. we also have a national process that is going on so it is going to require that because we are is a emergency start on the
local level. and all the state, local and federal and always in the process of developing any kind of incident action planning so are the association's like w.h.o. and all the others need to be part of the process of developing any kind of planning that goes and the federal so they can make the good of mind with the local levels because the local house apartments called me and many of them we were able to assuage them from that moving out on us and making sure that they stayed engage with us so it is very important that the federal doctrines translate into common languages that people can understand and appreciate and also comply with. >> having been involved in emergency response planning for several years i think it is always time to engage some key
sectors in really coming to terms with what the issues will be of the experience of a real event so i think the real legacy of what happened in new york city is that we have been able to leverage this experience to bring together other key partners including our emergency management partners and public safety partners as well as critical infrastructure to really think through the issues are begin to rethink the the issues with us hopefully in a more operational and realistic way in the event that we have immersive year pandemic in the fall and island and into that our health care planners who we have been able to engage must then some of the other sectors but there are some key lessons learned that we haven't expected with a surge on our emergency departments and clinics so we expected that, we thought we could minimize it with some public communication and it was more challenging. we learned a lot that will
hopefully give us opportunity to engage more broader spectrum of partners especially to deal with continuity of operations that will help with other emergencies as well. >> good morning again. again as i emphasize i think local involvement is very key and then i think it is very easy for indian tribes to be left out and i think it is very important and also in every indian community there are oil some resources that are unique and then i think they need to be involved, the tribal leaders need to be part of the discussion and again we have always said from the indian community that one size does not that all and have done a number of public campaign such as the work with cms on medicaid and medicare.
we have said over and over that indian tribes need to be involved and how you get the message across and then how you do your national campaign. we are being asked to do something and in the process of disseminating information we have to take that responsibility to break down, to inside information and then tried to get someone that can be able to convey the good information and the right information to all our customers so i think we can be able to establish that partnership early and then be able to be at the table. i think we can go a long ways. thank you. >> thanks, and there are questions from the floor, if you could go to the microphone and introduce yourself that would be great.
>> association of territorial. we talk about some populations i like to ask the panelists to comment on this. we had many undocumented individuals who fear coming forward for health care because they were afraid of legal action being taken. we have many people who work in the service sector and other industries where they have no set time and no benefits and if they do not work, they do not make money and they do not eat. we will have to deal with this issue if they stay home with their children or they do not go to work today are sick. can you comment on what we need to do to do with folks who are
undocumented said they're not afraid to seek care for themselves or their children, afraid of legal action. how will we assessed people that do not have benefits, which is a large part of our population, so that they can stay home with their children. >> both of those are very insightful questions. the undocumented question was very important to us in illinois state because we had 50 migrant camps, people were coming into the area and we had no idea of who was coming into the area. and they are usually followed by a mobile units to provide their medical care so we actually identified their infrastructure for health services and made a link with them but i think you're absolutely right, until that the stigma is removed warren had the ability for us in the federal level to say you are able to treat people without
repercussions for their status, we will have trouble with those populations people wanted to come forward voluntarily so i think it had to be a policy change and within our legal structure that we make the change but also how we deliver services and the community level, on the local level. the second part was i think we also need to talk about how to assist families that are coming in against the healthcare system and i can't afford to participate. when they are taking off from work i think the business community and that is where the leadership comes up and talking to businesses about how to take care of your workers that are valuable to you but are at a disadvantage because they don't have access to health care, how you change your policies and creative ways of dealing with that as far as scheduling and
also providing health care of services and house support for children who are ill the future they are treated in a proper environment so i think those resources and money to the school system and through the health care system needs to come to address that issue really for front and in a short time. we don't have a very long time to have this national model in place. does it require the right paper in requires action really. >> how will briefly comment on the last question because i agree, is a critical issue and when we did a survey is of the closed schools to get a sense of what people who were supposed to be staying home, there is a percentage of even high school kids who end knowledge that was schools are closing and a rail there were still going to work
so getting that message about staying home if you are ill is a critical johns especially for in more severe pandemic and facilitating that we need to ensure that all workplaces have policies that our billing to loosen up in the event of a pandemic to allow their workers to stay at home and provide the opportunity for them to work at home so that are not coming to the workplace and i think that responsibility needs to start with government policies of the federal, state and local levels some it is part of our pandemic discussions in the past and appear on an accelerated pandemic planning schedule as well specifically dealing with this issue within government as a month as are private business partners. >> the first american native people, there is always a mention of the treaty rights and
also the right to receive services in this country and oftentimes i think it has been raised again at one point they wanted to use december 2005 there was a model past and had to work on to deal with the need to have a citizenship and identity and. any time that anyone called for assistance from medicaid there was a requirement for the citizenship documentation and and what we learned in the process we hope this doesn't happen again. and is with navajo 17,500 navajo were over 60 years old and over 90% and not have a printer certificates and and even those under 60 including myself did have a birth certificates and we had a challenge to work on which was two really come up with some documentation that would show that we have the right to
receive services if we applied for medicaid, for example, so in these kind of discussion and think the hope that we work hard to fully understand it with indian tribes are at and then fully understand the counties in the states also need to work with us in terms of getting the information corrected. thank you. >> we're going to take these final two questions but i ask for very short questions and answers as well. >> thank you very much, when i heard the panel say this was a dress rehearsal and folks were still tired i was wondering about discussions about strategies for the marathon for public health and our other sectors of the local level, the federal level one thing that could help would be relieved of the state employees that are on federal funds. use 5% of their time for
emergencies and may be expanding that for the marathon and the strategy but i was wondering about local and state strategies of. >> , okay, for the state's strategy of one of the things we are looking at is merely one of the lessons learned from the spring and was how to rotate your staff and ensure that you're appropriately covering times and that your focus is in the right place as far as testing. a lot of the energy went into doing a lot of testing initially and that filicide because we started telling people not to come in for testing. it to stay home. also the cdc been a very good statement about air travel here it is already here so why are we comply with our airports. those things helped us to refocus our energies and move our staffing in the correct direction and is jim it correctly, but all the states are facing cutbacks right now, all the states are facing layoffs and and think that those
things cannot happen in the public health sector and education sector especially with this happening now and homeland security sector. this is the time it is critical, we don't know what will happen in the fall, these areas cannot afford to have cuts. if anything we should try to increase because in of the staffing shortage which pre-existing me actual pandemic itself. >> i will make a very brief comment which is something we instituted in new york city was a flame out or burn out policy and i want to emphasize how born in is to take care of ourselves during these things in the town for people working too many days in a row and to many hours and there's actually a limit on how many days to give work without taking a break. we had our mental health, part of the department of health and york city, actively doing outreach to make people taking breaks they needed. and having those plans in place ahead of time as well as a
rotating staff mike knightley -- and there was and as many people who rotate through. >> i just wanted to make a few comments. in these to the navajo nation and i think this is probably too for and that indian nations, we have what is, a navajo nation pandemic influenza plan that we're working on. every time that we deal with certain incident it does get updated and i think in some committees there is always a need to get some technical assistance to do that capacity so that is very important. and then the there is always a need of technical assistance. thank you. >> just a final question. really quick with dancers. >> out of my 27 questions, for the people of wisconsin, we know that we don't have the surge
capacity of skills, infectious disease, epidemiologist are emergencies like this one. we also have a chronically unaddressed massive epidemic that is ongoing in this country of sexually transmitted diseases. could we perhaps look at cdc level and the state level and beyond a hiring more communicable disease epidemiologist to work on the as to the epidemic and keep in reserve part massive emergencies like this fall? >> yes,, yes, yes. [laughter] but i also wanted to thank the the federal government and the speed and in the amount of interest, secretary sebelius and secretary napalitano come mcginnis bunning but there was a reinstitution of immunization of our public trust i think in the spring as well and i think we need to stay on that pathway. doing things like that making sure we have is that for
epidemiology and those things are moving in that direction. >> i am actually going to let that be the final comment. i would say that as cdc people from all over the agency were working on a response. are limited and i think that managing wish to have and the short-term to the highest priority areas is keen a matter what the response. i want to thank our panelists and the audience for their participation. [applause] >> next, friends and colleagues on the life and car rear of supreme court justice -- life and career of supreme court justice nominee sotomayor.
then, "q&a" with two authors. tomorrow on "washington journal" a supreme court reporter for usa today previews the confirmation hearings for sonia sotomayor. shane harris looks at congress' ' s role in strengthening the intelligence agency. we will have someone discussing defense authorization bill, which the senate will pick up this week. >> live coverage of the confirmation hearing for so near-sonia sotomayor starts monday at 10:00 a.m. eastern on c-span, c-span radio, and on the web at c-span.org. we will replay the hearings weeknights on c-span2. toward the homes to america's highest court, the supreme
court, on c-span. >> sonya sotomayor was born in 1954 in the bronx. this is the cork-apartment complex where she grew up. a look at the life and career of the judge threw her friends and colleagues. we big dutch begin with the columbia university law professor that knew her when they were students at yale university. >> i met her in my first year in moscow. we had a common friend and we met on a social occasion. we were loss students getting acclimated to a new situation. >> what did you have in common?
>> most importantly, we shared an interest in social justice. we both came to law school to advance that set of personal goals and immediately discovered that that was a common bond. we also really enjoyed trying to figure out what actually was going on in the world. we enjoy trying to analyze the culture that we were in. >> what was going on at that time? >> it was a very exciting place. we had a class of people who were very serious about themselves and their futures. there were many discussions about the role of the law as an agent of change and as a an agent of stability. there was a lot of discussion of
that. we were in the second wave of women. there were 41 women in our class out of 180 students. very few faculty who were women. we were navigating our way into a world that had opened up to us, but we were relative newcomers. that was part of the journey. i came from brown university. >> did she ever talk about princeton and how she made that transition? >> i cannot say that was a big subject of discussion. we were focused on the work that we were doing. we were law journal colleagues together. some talk about what it was like to write an article for the law journal. we both decided to play our leadership roles elsewhere besides in the law journal.
there was a lot of discussion of that as well. >> what was paroled? -- her role? >> she was an editor. she worked on other people's articles and she wrote an article for the journal that was subsequently published. >> why have they law journal. who reads it and what is it for? >> we are trying to create knowledge to inform the practitioners of law, judges, policy makers, and other researchers. law students are also entering into the field and law journal articles are an opportunity to allow law students to express
their view, user research, and use it to talk about a pressing issue of the day. >> do you remember any of her articles? >> she wrote an article, i do not remember it with great precision, but it was on pr and the role of states' rights in allocating natural resources. in many ways, it was indicative of her as a thinker. it was motivated by a sense of justice, motivated by trying to understand problems, executed with great care and precision. in a very careful and close to reading of the case law. it was really trying to do a thorough and thoughtful job to advance lott and the best sense of the word, which is very
typical of her than and typical of her now. >> were you ever in a classroom situation together? >> i do not think we were in class together. we were both socializing. also, brainstorming ideas together in law school. >> let's talk about the brainstorming first. you went to different leadership roles. she went to what? >> she led a policy journal on the executive leadership of a policy journal. that was the part that i knew most about. i took the route of using law school as an opportunity to really develop ideas and really go in depth about an area that i thought was deeply important and
which i thought there was insufficient understanding. >> paint a picture of the two of you in a social setting or what ever you would do and what this exchange of ideas might have looked like. >> i am picturing us, i think in her apartment, i cannot be sure, with our feet up. simultaneously laughing, but really in a deep conversation and i would say constructive conflict around ideas that we were each trying to figure out where we fit in, but more importantly these larger set of
institutions and what it meant to be a lawyer and addressing the set of issues that we came into an initially out of a set of commitments, but we were now being socialized into a role. >> what did that mean? what was the relationship between one's role and what one was trying to accomplish? i remember being struck by at the time the degree to which she had a deep appreciation of role. figuring out what it initially meant to be a lawyer, a prosecutor, what it meant to be writing from a position of it bought journal editor as opposed to a reporter. what it meant to be an advocate versus a judge. i remember covering-having an initial set of conversations
about the relationship between role and content. content was shaped by the position and having a sense of someone who have this kind of passion for the law and a deep set of commitments to figuring out what the role meant, whether you were a judge or a legislator or an advocate. >> that has been some of the criticism of her. is she an advocate, is she a judge? >> i think that is a misunderstanding of her. what was clear then and i think has become much more clear to me now watching her on the bench and then having some conversations with her socially in the last year is what it means to have very strong sense of role is that she really
develops her opinions, were c stands -- she stands, and how she acquires, on what it means to be a judge. she is not an advocate. in law school, she was coming in and figuring out, where am i in this and what is the role that i want to occupy to be able to fulfill my public mission? having taken on the position of judge, i would say she is as committed to the legitimacy of that role as anyone i have ever seen. she is very careful. she reasons through the decisions and she is not advancing any kind of agenda as an advocate. that is what it means. it means that i am and this
position. what does one and the position of justice do in a way that would give credibility and legitimacy to the institution that you are a part of. that seems to be wired into how she operates. that is something that she started figuring out when she was in law school. >> that is the brainstorming side. now let's go to the social side. what did they do when they let their hair down? >> i do not think it will look like letting their hair down all that much. what i remember most is wonderful dinners. she was someone that really enjoyed good food of all different kinds. wonderful dinners -- >> that you went out to or you coach? >> i am that the coke.
-- cook. it was sonia and others doing really good food. it was deeper joy in conversations about issues a passionate interest to the group of people. then find the humor in that. she was somebody that was very serious and committed, but was also able to stand back with humility and laugh at herself and understand herself in relation to a broader group. one thing that i have to say that really stands out to me about her, that i think she has held to, even as she has become a judge, she was someone that really paid attention to the content of what you were saying, whoever you work, rather
than who you were. she would listen to a good argument or a persuasive view, whether it came from a person on the street or whether the supreme court justice. she was someone that paid very close attention to what people were saying and at the same time does not easily intimidated. she is someone that would push back if she did not agree and she would do it with grace and respect, but also making sure that she got to the bottom of things. that was something that was part of the enjoyment. we've would do it when we were brainstorming about our ideas. >> the peppering of lawyers that we hear that she is known for was happening between you and
your friends and a dinner party as well as in a classroom? >> sonia asks great, hard questions. she does so within interest that understands and a very deep level and then open mindedness about rethinking her own position if what she hears justifies that process. >> were there other social things that you would do b. hiatt -- besides dinners? sports, cards, games? >> we would listen to music. i would have to say, what stands out in my mind is food and the conversation. >> where would she fit in terms of the class? were there many other latinos in the class? >> no. very few, actually.
she was breaking new ground, although she was not somebody who presented herself with that as her mark of identity. she was somebody that ming gold with a wide range of people. -- mingled with a wide range of people. she celebrated where she came from, but she did not define herself by it. she was someone that was very welcome to braided into the intellectual life of the law school. -- well integrated into the intellectual life of the law school. she is somebody that was very active in some of the social
issues that were relevant at the time. if i am remembering correctly, this does not stand up very visibly. she did some clinical work while she was at law school and was very involved in that community as well. she was active. this was not something that i had direct contact with. she was active in the latino organizations at yale. she played a leadership role in that as well. she wore many hats in law school. she was a very active presence. >> to do you remember your graduation? >> i remember it vaguely. >> were you all together? or their goodbyes? how did that work?
-- were there good-byes? how did that work? >> we were all together and there is a cocktail party afterwards. if there was a chance to say our goodbyes and reminisce. >> have you seen her since then? >> since i came to columbia, i join the faculty and visited in 1999 and joined the faculty in 2000, which have rekindled are friendship. -- our friendship. we both speak about potential law clerks. we talk about teaching. we have had dinner on a number of occasions to basically share our lives. >> we will have live coverage of the confirmation hearing beginning at 10:00 a.m. on c- span, c-span radio, and c- span.org. we talked about the confirmation
process with michael o'neill, chief counsel of the senate judiciary committee who is now at the george mason school of law and arlington, virginia. >> i was primarily past with advising the judiciary committee, specifically senator specter, as well as other republican members of the committee. in terms of getting the hearings rolling and briefing the members as they prepare for the hearings and also the staff director of the hearing, we had a considerable staff and higher prior to this. >> what was the size of this committee? >> there were around 60 plus lawyers and support staff and professional staff. not all of those people were working on the hearing. we hired separate people to work on the supreme court hearings themselves. we had a full legislative agenda that we were a working on.
sinking of the titanic, 1923, teapot dome,, or nuclear confrontation. this committee, with the leadership of senator leahy, has moved to a bipartisan approach. we had a confirmation of the attorney general, we repoake th vision a reality. mr. chairman, i come before the committee with no agenda. i have no platform. judges are not politicians who can promise to do certain things in
my director tells me where to speak and zero where to go. i am thankful for that. in this audience, i believe there are going to be a lot of questions. he tells me where to go, how to do it. thank you very much for inviting us all here. guantanamo is a true joint force. we want to talk a little bit about that. at this moment oone i do not wat to miss anybody. there are five service representatives in our commanding general. there are many other agencies also incorporated there. we are approaching 30 minutes,
but i guarantee it will be 20 minutes. i will set aside time for questions. i will explain how this affects the daily operations there. we bring together all branches of service in order to complete our mission. we have about 5000 people, 2000 our service members. i want to recognize a colonel from a place based in miami. thank you for being here with us tonight. [applause] we have the army which is in charge of the maximum security camps as well as others. the navy is in charge of media security camps. the coast guard provides support
security and security for a particular complex. the marines have a particular mission. the air force takes care of air transportation. based emergence engineer which is new. we have them in different groups in guantanamo. this is a very important base for strategic purposes due to its location in the gulf.
this is the only department of defense located at the southeast city of cuba. it is eight protected harbor. -- it is a protected harbor. normally katie provides greater protection -- haiti provides a great protection. this was designed as a u.s. base in an agreement. a formal treaty was established later in 1934 and later in 1963.
it is legally binding and has no ending date as long as the u.s. government fulfills the requirements which it is maintained based on a permanent basis, maintain the shipping channels, and make a payment for over $4,000. u.s. abandonment of the property can terminate the lease. guantanamo is protected by 70 miles of fence line surrounded by -- 70 miles of fence line.
along with the five services with it, there are many agencies as well. as indicated on this slide, they work alongside with our troopers. there are many task force agencies to help us. we will go into the different details with the fbi, criminal investigation, and so forth, different agencies. this picture is one of the prison camps. it describes our first mission. sake, humane, legal transparent care and custody of detainees.
that is the main mission we have is to keep the individuals safe. many of representatives visited our facilities. more than 2700 news media has visited this place since 2002. in 2008, we received 1800 legal visits. there is access to the detainees on a regular basis. in the middle of a photo, there is a person who is in charge of watching the detainees.
they are working in their shift. our second issue is intelligence. it @ two primary functions. the first primary function is to support the mission which is to protect guards. the second function is to assist in endeavors and to aid the law enforcement efforts. this is a picture of the route that the detainees can choose to sit or decline at their request. -- or recline at their request.
treatment of detainees at all times. there is a lot of controversy surrounding the medical mission during detention. the conditions of the detention in guantanamo is not available. but what safe, humane, illegal transportation of the detainees. it includes those convicted by military formations and those ordered released by a court.
the population is about 230. they represent about 30 countries and languages. the ages range from 22 years old to 61 years old with the average age of 35 years old. some detainees have been transferred and released. they are in other areas. there are various levels of the tension there. there are nine different camps. they are placed in different detention facilities depending on their current behavior, not of what they were doing when they were apprehended. we have a state of the art maximum-security facility.
they go from noncompliant to highly compliant. we have camp no. 7 which is where we have detainee's given the same food in treatment, but their location is not disclosed for security reasons. we have a communal community for those detainees with the court ordered release. there are about 1100 guards. they are comprised of army and navy personnel. they received training before
writing to make sure -- before arriving to make sure they can maintain a professional requirements in detail -- in watching the detainees. they have a variety of backgrounds. guards range in the age of 19 years old and 25 years old. they are very young service members. this is probably their first deployment in their life. you can imagine later what they go through. there are other things i want to point out. guards watched detainees at a
minimum of a certain amount of amendments every day of the week. the assignment is gender neutral. about 70% female that we have been the force. the guard's report on a daily basis. hitting, spitting, throwing body fluid, anything that comes from your body, any thing -- later we can elaborate more. that is why we have the
restoration team. they provide outreach to prevent this. they have access to other outlets to do with the stress of their daily duties such as a chaplain, recreation, activities, scuba diving, sailing, and others. as we speak, we are still constructing and enhancing and improving the programs for them. programs are available to provide intellectual
stimulation, instructional training, and socialization. the library with over 14,000 items in many languages is there. the library also has dvd is and cities. -- dvds and cds they are offered at three mills on a daily basis. these mills meet cultural and dietary requirements -- meals meet cultural and dietary requirements.
classes. art classes are offered. they are always interest to keep intellectual stimulation active. there are leaders, bankers, communicator's and others. the violence and physical assaults are also attempted on the guard population. they practice informational information by using the media, lawyers, an international organizations to spread their stories about mistreatment. they have become very creative
in making weapons out of any items that they might come into contact with with or part of their daily routine. a training manual was found in at the apartment of a suspected al qaeda members. this document provided instructions on topics such as forgery, assassination. active terrorist activities are dealt with in the camps here. we can go in more detail later.
we give humane medical care according to u.s. standards. they receive the same care as u.s. service members. the detainees receive equivalent care regardless of their status. some of the constraints we experience is that a specialist must be brought to help with the standard of care. initially it was refused. we went through a lot to buy specific surgeon or specialist. it is important to note that the
medical group works with the intelligence group and other operations. age group has all language and a translator. reach -- each group has their own language and their own translator. a dna has an examination -- a detainee as an examination and assessment. all of them have access to care 24 hours seven days a week provided by a core staff of a physician's, dentists, and other medical staff. they dispense one under 55,000 medications on an annual basis.
about 3500 visits are made on an annual basis as well. 1400 appointments and visits are scheduled. the ratio, and this is very strong, the ratio is 1 to 2 of health-care providers to detainees. brig provide any specialty care needed. even if the specialist has to be flown to guantanamo bay. we do a physical therapy, cardiology, as well as others.
the toll used for this procedure is the size and flexibility of a spaghetti noodle. the detainees are usually given two * of formula. -- two types of a formula. lately they have been asking for flavors such as strawberry. [laughter] about an hour later, they are full without chewing. they can have a conversation and chat among themselves. this is not a painful procedure. they have learned that they can be fed in one hour. they try to prolong the beating so they can have more
are many. it is more of an interview. information obtained has been of great value to the u.s. and our allies in reducing terrorism, preventing more training, planning for more attacks. the information is also of great value to u.s. and international law and other agencies. joint intelligence analyst provide support for the u.s. federal court. in conclusion, guantanamo bay in is not what it is portrayed in the media.
we do not have plugthugs inside working there. they are troopers. they could be your son or your daughter. they are doing a top mission and are doing it very well. thank you very much. i look forward to your questions. [applause] we can therefore a discussion. no questions? yes. >> i do not understand the response from some american politicians. if you assume theoretically that
you move your prison camps to any large american military base, if you move the whole operations, would there be any danger to the surrounding population? >> we do have some terrorist subjects. in going specifically into that question, that as a policymaker question. i have to rely on my mission we will do anything to protect our nation. that is one of the three missions we have. do you want to say something? >> a lot of times, we will get a
lot of questions that relate to more policy type related questions. that question, we have media, all of the time. >> if i may rephrase the question. i am not asking whether it should be moved. if it were moved, if the president decided to move sis' to an air said -- air force base, would there be any danger to the civilian population? >> as we mentioned previously, we have about two dozen
soldiers that are well oriented in what we are doing. -- you saw the different facilities that we have built an enhanced through the last three years or so. they are secure. we are sick. -- we are safeguarding. if we were to place them somewhere else, can answer. >> you did not answer it. >> i am learning. we have a lot of human resources down in guantanamo.
>> you sent to thousand military employees and 5000 civilian employees. >> yes. >> -- you said there were 2000 millet terry employees -- military employees and 5000 civilian employees. >> yes. out of the 2200 service members, we have about 5000 civilians which includes contractors. we have to continue -- every time we have an inspection or audit from the red cross or the report, you have to improve the
facility which we are doing now. for eight civilian for each operation, we have to make -- for each civilian or each operation, we have to make adjustments and improvement. >> the total number of personnel, keep in mind, it affects the entirety of the u.s. naval station there at guantanamo bay. they are conducting a lot of operations within the 45 square mile area. there is a joint task force one of guantanamo. there are just over two dozen people doing missions with joint task force. -- 2000 people doing missions
with the joint task force. that is the group during the mission we have been discussing here specifically. >> the task force is totally separate from guantanamo bay. we're talking about the detainee operations. we have to separate both subject. >> [inaudible] civilian employees are doing what the military has lucked out over the years.
>> the facility costs about 47 million. the other one about 47 50 million. to under 95 million. -- to under 95 million. -- 295 million. >> to talk about the ritual of the soldiers per the prisoners. is that the same at guantanamo as it would be on or off the shore? the media always focuses on water boarding. i think it has had one of results. [laughter] in your comment tonight, it looked more like a lounge at an airport and a torture chamber. can you comment on that? >> water boarding, since i read
we cannot downsize the force because we have a facility and we have a 50 man force, we would have to maintain that. we would not downsize. if we placed the facilities someplace else, that is different from my mission. i cannot answer that. >> how does that ratio compared to other facilities? i do not know specifically.
we are a very specialized facility and organization. i cannot speak for other places. the closest thing we can compare it to is the federal bureau prisons and things of that sort. i do not know the ratio of debt. -- ratio of that. i do not believe you will find the ratio to be very different. >> we can translate from one language to another. there are cases where we have the masterminds. these are excellent facilities.
>> speaking of camp x-ray and the transition to the other camp, it was used during a short time frame at the start of the transfer of individuals to guantanamo. during that time, the fatality buildup to camps 12 and 3. -- during that time, the facility was built up to camp's one, too, and three. later we added the other camps. >> there were some polk --
pictures posted in 2002. that is a point of view. they get noncompliance of their would place them in the corn suits. we deny use that. we use white or cream because it is easier to look at an easier to clean. >> you mentioned earlier that they are not placed in to the camps based on their conduct for camps 4, 5, 6. and when they first arrive, how do you assess where they will be placed? >> they were in camps 1, 2, 3, 4, and then by gathering in
their behavior, our own force would see if they were going to make harm to themselves. then we would place them in another facility. >> when the detainees are showing they are able to be compliant and can follow camp rules and get along well with others, that is the determining factor. if you can follow the rules and get along well with others, you're not assaulting the guards or other detainees, you could be able to be put in to a communal environment. more than half are in a communal environment at this time.
>> they have plenty hours of recreation. >> what about the correspondence being sent into the detainees? can you tell us how you prevent certain secret codes put into the letters? what is the process put into that? >> 1 artefact they may use its toilet tissue. the wet and swallow it. we have to be careful what amount of toilet paper we give them. the court around the cell, we have to be careful.
>> there are various ways of communication among the detainees. anything that does come in is screened appropriately according to our standard operations system. there are legal visits. information can go through this authorized channels. >> did we answer your question? >> yes. >> naive spent some time with president obama and -- have you spent time with president obama and showed him this power. ? -- power point?
from the government coming down there. we have had visits from the department of justice. i do know the information is being communicated. what i would like people to remember is that we are a military organization. we are following the orders given to us. a lot of policy questions are out there. what about the white house and the department of justice? we take the orders that are given to us. we conduct our business following the orders. if a decision is made it that the facility needs to be closed for the executive order, we will follow the orders given to us
directing us toward that end. if the other orders come in after the fact, we will follow those orders. i want to make sure people understand a lot of policy questions, but joint task force guantanamo led by these generals, we follow the orders of the officers appointed over us. i want to make sure people understand that. >> did we into your question? ok. [laughter] >> earlier you mentioned that outsiders do visit with the detainees. can you elaborate on the frequency, the scope, and some of the nature of the contact and that these people have with the detainees.
>> very frequent. >> there were over 1000 attorney-client visits scheduled. they are scheduled depending on what procedure they are in. they submit their schedule. there is no amount of time. we accommodate as necessary. there are specific meeting times. they have a point of contact for counsel. the meetings can happen seven days a week. the amount and frequency of the meetings depend on the council. does that answer your question? >> thank you.
>> thank you for coming. as far as operations, where do you see the future of the base as far as the long-term goals changing? what do you see for now and in the future? >> we will continue with the orders we have received from the president until they are completed. as a joint task force, we will maintain our mandate as long as we have orders to do so. >> keep in mind, this has been
in operation for over 100 years at guantanamo bay. we have had a lot of operations over the years. a lot of military personnel in and out over the last century. we have had a visit just a couple of months ago. the secretary of the navy showed up and made some comments that this has been an important asset to the nation for the last century. he envisioned it would be so in the future as well. joint task force guantanamo that we represent is just under 4 square miles of land on that 45 square-mile base. there is a long history there. it is an important asset to the u.s. government. what happens to the specific miles of land that we are on a,
if we were to go away, a lot of discussion to happen about that. there is a lot more land and activity and other personnel who continue to work there providing a lot of other activities for the u.s. government at the facility. there is a lot of history to be made. >> i'd like to ask you a question about [inaudible] , what about those who have been released? >> about 94 have come back. this is a family business.
from grandson of the way to grandpa. when they go back to their country, today sometimes become heroes from guantanamo. that is a situation we are confronting. >> i have a couple of questions if you can answer them. you said you have a certain amount of detainees there with a three devil -- three different levels of security. >> we have less than 20 dangerous or highly secured the kidneys. >> those situations in which intelligence -- has intelligence from guantanamo
discovered attack on the united states -- discovered attacks on the united states that would lead to prevention of those attacks? >> we believe so. >> thank you. >> this is not going to be an easy one. knowledge -- a heavy loss jenny -- and name people and as a result of them being a homosexual? >> not to my knowledge.
>> the majority of translators are contractors. to our knowledge, i am not aware of anyone being sent back. as far as their sexual orientation, i do not know if there is a clause in their contract regarding that. >> yes. >> is a question for you. >> i have to be careful with that. >> what are some of the headaches you experience in the camps? >> i work the camps every day.
the most difficult is maintaining their motivation because of the media they are receiving, the way they treat the detainees -- there are -- it is tough for them. they are very young. that emotional part of the job, the human aspect of a soldier, we have to work with them. it is a great opportunity to mention what we are doing and how we are performing over there by inviting me here today.
the care, medical group, intelligence gathering, and that is an easy task. maintaining motivation, dealing with home cygnus, that is difficult. that is a reality. -- home sickness, that is difficult. that is a reality. i work of the camps every day. day, night, evening, morning. >> i spent 95 on the dmv. they would say the word unification in korean. my question is about cuba. what is the relationship or the
we have no issue with the other side of the fence. they stay on their side, and we stay on our side. >> the location is in a very remote location of guantanamo bay. a lot of people think, what is on the other side of the gate. there is no town there. keep that in mind. we have good relations in that regard in maintaining the ability to help each other in case of natural disasters.
>> ok. thank you very much. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009] >> before we conclude, we have a plaque to present to the general. it is from the federalist society in miami, florida. with our sincere thanks and appreciation. you honor us by your presence. >> thank you very much. [applause] >> let me present